Addiction Managementhttp://addictionmanagement.org
Helping People Understand and Overcome AddictionSat, 24 Jan 2015 20:26:30 +0000en-UShourly1http://wordpress.org/?v=4.0.1Why You Should Know About Implementation Sciencehttp://addictionmanagement.org/know-implementation-science/
http://addictionmanagement.org/know-implementation-science/#commentsWed, 21 Jan 2015 13:55:23 +0000http://addictionmanagement.org/?p=3997Years ago I attended a conference where I first learned of the work of Dean Fixsen and heard the phrase implementation science. What I most remember about his presentation is a PowerPoint slide he showed that to this day continues to haunt me: The table is taken from Joyce and Showers (2002) where the authors... [Continue Reading]

]]>Years ago I attended a conference where I first learned of the work of Dean Fixsen and heard the phrase implementation science. What I most remember about his presentation is a PowerPoint slide he showed that to this day continues to haunt me:

The table is taken from Joyce and Showers (2002) where the authors were interested in studying the percent of teachers who actually utilized a new skill they had learned in practice. If you take a few minutes to study the table, you will see that for the new skill to be used in the classroom, it was necessary to:

Discuss the theory behind the new skill

Demonstrate the new skill

Allow teachers to practice the new skill and get feedback on their performance

Coach the teachers on the new skill in the real-world classroom

And if you take away the final component – coaching in the real-world – use in the classroom drops from 95% to 5%!

I have spent two decades of life energy in classrooms working on my own degrees, and another half-dozen years teaching in classrooms. Most of the time the learning took place in classrooms, and most of it was discussing theory in a group setting. Now can you begin to understand why this slide haunts me?

I know education is about a lot of things, but students today need knowledge and skills that they can use in the real world, and we are failing them in so many ways (while we continue to up the price of education).

Implementation Science Applied to Addiction Management

This study has implications that go far beyond the classroom. The field of implementation science is all about understanding what it takes for evidence-based practices to actually be used in practice. It’s the science that fills the gap between research and practice. While the field continues to remain unknown to most who work in the addiction treatment field (and sadly other healthcare settings), I believe the principals of implementation science can and should be used by anyone desiring to overcome addiction, trauma, or any behavioral health problem.

How do you implement the principals from implementation science into your day-to-day efforts to change difficult things?

Learn more about implementation science. Like most things in life, knowledge is power. So take some time to read up on what we know about successful behavior change. A solid place to start is Implementation Research: A Synthesis of the Literature. You can also watch Dean Fixsen in action giving an overview of the topic on YouTube. I will add that the field has not done the best job of developing resources for the general public, so know that there is no need to become a scholar on this stuff, just gain enough insight to know that the key ingredient to successful behavior change is coaching.

Get coaching. I know, you saw this one coming. It’s not easy teaching an old dog new tricks (or even a young one for that matter)! Those who have struggled with addiction and engaged in treatment know that behavior change is hard work. But it can be a lot easier if you find people who have successfully implemented new routines, skills, and behaviors into their life, and get them to coach you on doing the same. This idea is of course what sponsors are all about in 12 Step programs. We know that exercise, mindfulness meditation, eating right, learning to manage emotions, and successfully overcoming relapse triggers all require skills that can benefit from coaching. But know that I am not advocating you spend your precious time and money on general life coaching. This field is littered with many unlicensed helpers who often mean good, but have no business coaching others. While I know there are some solid general life coaches out there, seek out experts with a track record in the specific skillsyou want to acquire.

Utilize intensive outpatient treatment instead of residential. Why would this be so you ask? Because principals of implementation science tell us that when you learn and practice new skills in real-world settings the outcomes are better. My good friend Dennis McCarty and his colleagues recently published Substance Abuse Intensive Outpatient Programs: Assessing the Evidence where they concluded that intensive outpatient is as effective as residential for most individuals, at a fraction of the cost. There are a number of reasons for this, but an important one is because they force those in treatment to practice new skills in the real world.

I know education is a life-long process and am hopeful that one day my haunting will end. I do seek out experts to help me learn things that are important to me, and am often amazed at how a little coaching can take me a lot farther than I ever imagined.

]]>http://addictionmanagement.org/know-implementation-science/feed/6American Sniper the Movie, PTSD & Addictionhttp://addictionmanagement.org/american-sniper-the-movie-ptsd-addiction/
http://addictionmanagement.org/american-sniper-the-movie-ptsd-addiction/#commentsTue, 20 Jan 2015 05:22:51 +0000http://addictionmanagement.org/?p=3985I saw American Sniper yesterday and like many, was emotionally stirred by Clint Eastwood’s depiction of the life of Chris Kyle. Had I not seen The Hurt Locker (2008) and Zero Dark Thirty (2012), watching the graphic deaths of women and children in war would have been even more horrific. Sadly, if movies have... [Continue Reading]

]]>I saw American Sniper yesterday and like many, was emotionally stirred by Clint Eastwood’s depiction of the life of Chris Kyle.

Had I not seen The Hurt Locker (2008) and Zero Dark Thirty (2012), watching the graphic deaths of women and children in war would have been even more horrific. Sadly, if movies have to compete with CNN, then we are sure to see more over-the-top violence in movies to come. What I wish we would see more of is the human side of the story which I know is harder to tell (and sell).

After four tours of duty and 160 kills to his name – as you might suspect – Chris comes home a changed man. His post-traumatic stress symptoms and healing are embedded in the story, but more as a side show. We experience him sitting alone at a bar drinking, having one brief encounter with a therapist, and helping some other vets. And then miraculously his PTSD is cured, or so it seems.

To be fair, I have not read the book and mean no disrespect to Chris. There is likely a lot more to this part of the story, but Clint and his team chose to gloss over it. For most who go to war, let alone experience four tours of duty on the front lines, addressing PTSD goes far beyond one therapy session. If you want to see a more powerful depiction of PTSD and how it unfolds, watch Brothers.

We are miserably failing both active-duty personnel and veterans who struggle with trauma and addiction. Reports from the Institute of Medicine (PTSD, Substance Abuse) provide evidence that we need to do a lot more to help those sufferings. But what do we do?

While both IOM reports detail recommendations for improving care, if you are presently in pain, they offer little help. Thus I offer the following suggestions, with the caveat that there really are no simple solutions.

Education. If you are suffering, or know someone who is and are unsure how to help, then your first priority is learning as much as you can about trauma and addiction. Once you understand how traumatic events and addiction alter the brain, body and emotional systems, the hope of healing becomes more than possible. For learning about addiction, check out the material on this website. For trauma, read Waking the Tiger, The Body Remembers, The Body Keeps the Score, and In an Unspoken Voice. Also, check out David Baldwin’s Trauma Information Pages. These resources alone, if read by active-duty personnel, vets, and family members, would be life-altering.

Hyperarousal. It’s hard to function in life when blood pressure is through the roof and normal sights, sounds, and smells trigger a flood of chemicals that prepare the body for a life or death battle. While such reactions can be life-saving in the field, they are not such a good thing when you are wanting to successfully reengage in civilian life. Among the best antidotes to address hyperarousal is yoga, breath work, martial arts, and emotion-regulation skills. All of these are discussed in the above mentioned books, so there is no shortage of methods. While medications can be useful, often they can be avoided by engaging in these behavioral interventions.

Mindfulness. Healing from trauma requires self-awareness. You must learn to reinhabit your body by gradually noticing what your thoughts, feelings and sensations do under different circumstances. There is a significant literature on the benefits of mindfulness for all people, but if you suffer from trauma and addiction, it may be the most important key. If you use alcohol, illicit drugs, pain medication, or gamble to medicate PTSD symptoms, you must become mindful of when and how addiction plays a role in keeping you stuck in life. Check out the site Mindful and Jon Kabat-Zinn’s book Full Catastrophe Living.

Therapy. While it’s not always necessary to seek therapy for treatment of trauma and addiction, both tend to be complex challenging problems that benefit from someone who can coach you to health. The key is getting good therapy that goes beyond talk therapy. There are a number of evidence-based treatments like EMDR, Internal Family Systems Therapy, Somatic Experiencing, and Sensorimotor Psychotherapy that require a trained therapist to implement the approach. How to find a good therapist, pay for treatment, and ensure good outcomes go beyond this post, but by exploring the links herein I believe you will be armed with knowledge that will help you find what you need.

Lastly, we tend to think of trauma and addiction as pathological problems requiring professional diagnosis and intervention. But in truth, these problems are actually normal responses to abnormal life experiences. I hate that we pathologize human behaviors that at their core actually help us to survive! It’s why my 5 Actions model of intervention embraces the healing power of creativity.

]]>http://addictionmanagement.org/american-sniper-the-movie-ptsd-addiction/feed/2When Unknown Traumatic Events Fuel Addictionhttp://addictionmanagement.org/traumatic-events-fuels-addiction/
http://addictionmanagement.org/traumatic-events-fuels-addiction/#commentsSun, 23 Nov 2014 17:01:50 +0000http://addictionmanagement.org/?p=3949In Bessel van der Kolk’s latest masterpiece, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma he writes about a study specific to traumatic memory that I believe has significant implications for those who struggle with addiction. The study takes us into the science of repressed memory, and helps prove that often... [Continue Reading]

]]>In Bessel van der Kolk’s latest masterpiece, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma he writes about a study specific to traumatic memory that I believe has significant implications for those who struggle with addiction. The study takes us into the science of repressed memory, and helps prove that often traumatic events from the past that fuel present addictive behavior, cannot be remembered.

Study on Women’s Memory of Childhood Sexual Abuse

Back in the early 1970s, Dr. Linda Meyer Williams was a graduate student studying sexual abuse. She interviewed 206 girls (ages 10 to 12) who had been admitted to a hospital following a sexual abuse incident. She also interviewed the parents, confirmed lab tests, and made sure that all the information was meticulously recorded in the medical record.

Then, 17 years later she tracked down 129 of the children and interviewed them again about their prior abuse experience to find out:

Do people actually forget traumatic events such as child sexual abuse, and if so, how common is such forgetting?

The outcome of the study: 38% did not recall being sexually abused. This study is just one among many that help us to understand that traumatic events are often completely forgotten. One reason is that when the events occur, they do not get recorded in the memory systems of the brain in the same way as other memories. They get recorded as dissociated fragments of experience and disconnected sensations in the body, thus a coherent story of the event simply does not exist in memory.

Traumatic Events and Addiction

Fast forward years later. You seek treatment for drinking, drugging, gambling, or perhaps acting out sexually or with food, and the interventions you receive focus on helping you develop a recovery lifestyle. But how successful are your efforts to abstain following treatment, when the flame that fuels your addiction is not even known?

To successfully overcome addiction most often requires some work on resolving past traumatic events, even when such experiences are foggy or forgotten. Fortunately, it’s not absolutely necessary that trauma be fully remembered to treat it and remove its influence on addictive behavior. But – and this is a big but – to treat trauma requires more than talk therapy. It requires an approach that involves the body, emotions, and integrating the head and the heart. And it requires patience, safety, and in most cases help from a trained clinician.

If you have been to treatment for addiction and continue to struggle, exploring the potential role of unresolved past traumatic events may be the missing key that allows you to permanently turn a corner on your addiction.

]]>http://addictionmanagement.org/traumatic-events-fuels-addiction/feed/26The Magic of the Moment: Mindfulness and Addictionhttp://addictionmanagement.org/magic-moment-mindfulness-and-addiction/
http://addictionmanagement.org/magic-moment-mindfulness-and-addiction/#commentsThu, 02 Oct 2014 22:24:21 +0000http://addictionmanagement.org/?p=3902I went to a lecture the other night on Seeing Color & Enhancing Creativity presented by photographer Seth Resnick. To warm up he had the audience close their eyes and picture what the person next to them was wearing. Because many couldn’t do it, he used the exercise to illustrate just how much we miss... [Continue Reading]

]]>I went to a lecture the other night on Seeing Color & Enhancing Creativity presented by photographer Seth Resnick. To warm up he had the audience close their eyes and picture what the person next to them was wearing. Because many couldn’t do it, he used the exercise to illustrate just how much we miss even when something is right in front of us.

Walking By Joshua Bell

Seth’s warmup exercise reminded me of the Washington Post’s subway experiment where world renowned violinist Joshua Bell, disguised as just another street musician, played music during morning rush hour in a Washington DC metro station. Every time I watch the Joshua Bell subway video it makes me cry.

In 43 minutes of playing some of the most beautiful music ever written – 1,097 people – most on their way to work – walked right on by. The few that listened dropped a grand total of $32.17 into Joshua Bell’s hat. Only one woman recognized him. Never did a crowd gather. If we are unable to break out of our daily trance when moments like Joshua Bell emerge, what else are we missing in our life?

We currently live in a world consumed by speed, instant gratification, and crazy schedules. I believe our lifestyles contribute significantly to not seeing the truth and beauty that is right in front of us. I cry because we miss our kid’s smile, the squirrel scampering across the fence, the smell of rain, the warmth of the sun. Every day we hurry around in our own bubbles of busyness, missing out on the life that is right in front of us.

Mindfulness and Addiction

To overcome addiction requires enhancing your ability to see. You must learn to recognize the patterns that lead up to acting out, and awaken to what you really want in the moment you decide to inject a drug, put money on the poker table, or take another sip of wine. This is easier said than done, because when addiction is active it puts your brain in an altered trance-like state that makes it challenging to fully experience the present moment.

One way to break out of the trance – and out of addiction – is getting good at being present. The best way to do this is by developing a mindfulness practice that over time helps you connect to the magic of the moment. It’s magical because it’s in the present that we experience life and have the opportunity to proactively influence our future and change behavior.

5 ways to build a mindfulness practice:

2) Pick a method of mindfulness practice that appeals to you, and that you can commit to doing for a trial period of time – say 90 days.

3) If the various methods discussed in the above sites don’t appeal to you, think about which sense (or senses) engages you most in the world – sight, smell, sound, touch, taste – and then learn to use that sense as way into your deeper self and the world around you.

For example, the images I create from taking pictures are mirrors of my internal world. They help me better understand myself, what I care about, what I focus on, what I see – and what I don’t see! Photography for me has become a mindfulness practice. But the same can be true of cooking, making music, being a masseuse, or any other discipline that relies strongly upon our senses.

4) Develop a daily habit of incorporating your practice into your life by making time for it, prioritizing it, and doing it no matter what particular rollercoaster life takes you on. Pick a simple and easy way to track progress, such as assessing daily your level of calm energy and stress, and perhaps how it influences your addictive behavior.

5) There is no right or wrong when it comes to developing a mindfulness practice. You can stop, change, or make adjustments along the way. The key is finding a way to live in the present moment as much as possible, where you are fully awake, aware, and able to decide how you will respond to any given moment. It is also in the present, in the gap between stimulus and response, where you consciously do what you need to do to overcome addiction.

]]>http://addictionmanagement.org/magic-moment-mindfulness-and-addiction/feed/29Is There an Easy Way to Stop Smoking?http://addictionmanagement.org/an-easy-way-stop-smoking/
http://addictionmanagement.org/an-easy-way-stop-smoking/#commentsMon, 29 Sep 2014 03:24:18 +0000http://addictionmanagement.org/?p=3885Have you heard of Allen Carr’s book an Easy Way to Stop Smoking? The approach developed by an accountant turned addiction guru may be the single most profitable addiction treatment intervention ever developed. His stop smoking books have sold over 10 million copies in 57 countries, and his organization now offers treatment seminars in 150 cities... [Continue Reading]

]]>Have you heard of Allen Carr’s book an Easy Way to Stop Smoking? The approach developed by an accountant turned addiction guru may be the single most profitable addiction treatment intervention ever developed. His stop smoking books have sold over 10 million copies in 57 countries, and his organization now offers treatment seminars in 150 cities in 45 countries. While Allen died in 2006, his method lives on and is also marketed to those in need of help with alcohol, drug, and food addiction problems.

So what’s the Easyway®? In a nutshell it’s the idea that we all have the power within ourselves to decide our own fate. So the solution to addiction is quite easy on the surface; you just need to make the decision to stop engaging in addictive behaviors and then stick with that decision. Allen’s contribution to this process appears to be his way with words, which really is a sales pitch to get you to stop. No question he had an ability to get through to some people, because what else explains his phenomenal business success?

How many people have actually overcome their addictions permanently using his method? It’s unknown, which puts him into the same category as most treatment programs. Absent reliable addiction treatment outcomes, those who sell solutions are free to say whatever they want about their methods. And sadly, buyers who so badly want to end their addictions, will try most anything even if the chances are small that it will work.

Now I am not saying that his method is snake oil or does not work. In truth, it has worked for some people. But the more important question is how well does it work compared to other methods? This is where science, randomized clinical trials, and research can guide you to make wise choices about how you spend your time and money on solutions to addiction.

So when it comes to stop smoking, what does the science say?

Among the most reliable sources for answers consolidated from peer-reviewed research is the Cochrane Collaboration. If you spend just a few minutes reviewing the findings from the Cochrane Tobacco Addiction Group you will be armed with knowledge to decide what method may work best for you.

We are a society obsessed with quick fixes and simple solutions. While it’s a nice idea that overcoming addiction can be easy – and maybe for some it is – for most it’s a challenging problem that requires hard work, work that goes beyond just addressing the addiction.

]]>http://addictionmanagement.org/an-easy-way-stop-smoking/feed/33Addiction Treatment System – Not So Broken After Allhttp://addictionmanagement.org/treatment-for-addictions/
http://addictionmanagement.org/treatment-for-addictions/#commentsWed, 24 Sep 2014 16:00:49 +0000http://addictionmanagement.org/?p=2935I need to apologize to those who work in the addiction treatment field, because some of my past posts have contributed to the perception that we have a broken addiction treatment system. While I have never said or even implied that the people working in the field are broken, I know from experience that it doesn’t feel... [Continue Reading]

]]>I need to apologize to those who work in the addiction treatment field, because some of my past posts have contributed to the perception that we have a broken addiction treatment system. While I have never said or even implied that the people working in the field are broken, I know from experience that it doesn’t feel good continually hearing that the system in which one works is broken. But before I apologize, I have some explaining to do.

I am currently finishing up the writing of my upcoming Guide to Addiction Treatment that should be available next month. One of the aha moments while creating the eBook came when I realized that maybe the system is not so broken after all.

Map of Addiction

Maybe we have a lot of good treatment for addiction available, but it often fails those who struggle because we expect one treatment program, therapist, or approach to do everything necessary to overcome addiction.

Addiction is a problem that goes beyond just additive behaviors. It involves addressing underlying traumas, developmental gaps, isolation, and other complicating co-occurring disorders, all of which require time and attention. But you can’t address all of these things at once. The most pressing and potentially harmful behaviors are addressed first, such as: daily drinking, suicidal behavior, potential for domestic violence, or lack of basic needs (food, shelter, safety). Later, once acute issues are stabilized, problems that require more time and management can be addressed, like: trauma, developmental gaps, and chronic emotional and medical issues.

Within our present system there exists a wide range of treatment experts working in hospitals, residential programs, outpatient clinics, and private practice that can effectively address all of the issues necessary to overcome addiction. But the key is knowing which professionals to employ at which time – which is why I am writing the guide!

For now, know that combining time with different therapists in different treatment settings means you proactively create your own individualized addiction treatment system that is far from broken. Doing this is not so hard once you know what outcomes you seek, have a general map for how to reach your outcomes, and know a bit about what interventions work best depending on where you are at on the map.

So, I apologize to all of those who work in the addiction treatment field for globalizing the idea that our addiction treatment system is broken. While improvements can always be made in the delivery of care, perhaps we should focus more on how to best utilize what we have available right now – which is more than enough to help anyone find their way out of addiction.

Sign up for our newsletter to find out when the Guide to Addiction Treatment is available.

]]>http://addictionmanagement.org/treatment-for-addictions/feed/13Addiction and the Experience of Feeling Alivehttp://addictionmanagement.org/breaking-the-cycle-of-addiction-feel-alive/
http://addictionmanagement.org/breaking-the-cycle-of-addiction-feel-alive/#commentsTue, 16 Sep 2014 21:22:58 +0000http://addictionmanagement.org/?p=3619People say that what we’re all seeking is a meaning for life. I don’t think that’s what we’re really seeking. I think that what we’re seeking is an experience of being alive, so that our life experiences on the purely physical plane will have resonances within our innermost being and reality, so that we actually... [Continue Reading]

People say that what we’re all seeking is a meaning for life. I don’t think that’s what we’re really seeking. I think that what we’re seeking is an experience of being alive, so that our life experiences on the purely physical plane will have resonances within our innermost being and reality, so that we actually feel the rapture of being alive. Joseph Campbell, The Power of Myth

For those of you who have never heard of Joseph Campbell, he was a man who could tell a good story. In fact, his life was devoted to the study and teaching of mythology. He believed that myths – powerful stories passed on through the ages and across cultures – hold the truth of life.

More than any other scholar, Campbell awakened us to our need for these universal stories in finding our way during turbulent times.

Among his most popular reads is The Hero with a Thousand Faces, a book dedicated to describing the hero’s journey. Finding your way out of addiction is a hero’s journey. It’s about leaving the comforts of the known, and courageously seeking the truth of your existence. There is pain and sacrifice on the quest, and you constantly run up against a world that does not make your journey easy. At the same time Campbell says,

The ultimate dragon is within you, it is your ego clamping down on you.

The journey out of addiction is hard because your experience while acting out may be as close to the rapture of being alive as you have ever felt. So disconnecting feels like you must give up something that predictably (and habitually) delivers the feeling of aliveness. And herein lies the trick of the dragon. An addictive high may feel quite powerful, but it’s a poor substitute for the experience of being alive that Joseph Campbell believes we are all seeking.

So if you want to overcome addiction, you have no choice but to take your own hero’s journey.

If you realize what the real problem is – losing yourself, giving yourself to some higher end, or to another – you realize that this itself is the ultimate trial. When we quit thinking about ourselves and our own self-preservation, we undergo an truly heroic transformation of consciousness. Joseph Campbell, The Power of Myth

And how do you embark on your journey? Campbell offered some sound advice from his decades of studying the heroes who have gone before you.

Find and use good teachers along the way (or therapists, clergy, friends, coaches, etc.)

Read literature that speaks to your heart for where you are at on the journey

Do not neglect your inner journey, for inside you is where the real hero’s journey happens – so develop a contemplative side to life

“Follow your bliss” was Campbell’s general advice while on your journey

In truth we all are on the hero’s journey whether we are doing our best to overcome addiction, or battling another dragon of the ego. We may feel like we are stuck or not making progress, but the journey is not a linear one. Perhaps only when we get to the end and look back will life make more sense. And maybe then we will realize that what we sought for so long had been with us from the very beginning.

]]>http://addictionmanagement.org/breaking-the-cycle-of-addiction-feel-alive/feed/5Using Emotions vs Talk Therapy to Heal Addictionhttp://addictionmanagement.org/emotions-vs-talk-therapy/
http://addictionmanagement.org/emotions-vs-talk-therapy/#commentsTue, 19 Aug 2014 18:56:45 +0000http://addictionmanagement.org/?p=3557Have you received counseling or therapy to address addiction and still struggle? If so, you are not alone. When I consult with clients who have done lots of treatment, one of the first questions I always ask is: How much was talk therapy? This often leads to the deer-in-the-headlights look, because many believe there is... [Continue Reading]

]]>Have you received counseling or therapy to address addiction and still struggle? If so, you are not alone. When I consult with clients who have done lots of treatment, one of the first questions I always ask is:

How much was talk therapy?

This often leads to the deer-in-the-headlights look, because many believe there is no other kind of therapy. But they would be wrong, and I want you to understand why I believe healing addiction requires going beyond talk therapy.

Talk therapy is just that, it’s all about talking about your issues. I for one like this kind of therapy very much because it allows me to stay in my head where I am most comfortable.

I can talk and talk about all sorts of things, even painful topics, just so long as my therapist doesn’t slow me down to feel in my body what is happening when I talk about things. That’s when therapy becomes hard work, because feeling my feelings and emotions has never been easy! And I suspect it’s not so easy for you as well.

Why are feelings and emotions so challenging for those who struggle with addiction?

Over 80% of those who go down the path of addiction do so prior to the age of 15. One reason is that adverse childhood experiences are emotionally painful, and engaging in addictive behavior is a great antidote to disconnecting from the body and not having to feel the emotional pain from these early traumas. Used in this way, addiction is a naturally adaptive response to experiences that children should not have to endure, but many do.

The problem is that addiction can’t differentiate overwhelming emotions from all the others that are useful in life. So over time, while addiction works well to keep your emotions at bay, you inadvertently cheat yourself of the emotional, developmental experiences necessary for learning how be in healthy, intimate relationships. Why? Because emotional intelligence is at the heart of love, parenting, passionate work, and leading a good life.

Now can you see where I am going with the need for going beyond talk therapy?

If you are to overcome addiction you must learn how to become comfortable in your body and feel your feelings. This is an incredibly scary notion if for years you have lived in your head and fear being overwhelmed by your feelings. But there are therapies that can gradually help you enter your body and experience feelings without getting overwhelmed.

Many have been developed to help people heal from trauma, but they also are used to close the developmental gap between ones emotional and chronological age (see The Growth of the Mind for more on this topic).

What are these body-based feeling therapies exactly?

There are many and they go by various names. Here are a few that can help you get a feel for what I am talking about:

While there are many other approaches, the point of this entire post is to encourage you to seek out therapy from someone who can help you work with feelings and emotions in your body, if you have not done this already.

Finding a therapist to do this may sound easy, but my experience is that it may take some work on your part. Why? Because finding a therapist that really knows how to work with emotion and the body requires finding someone who has done this work themselves! And many therapists – although well intentioned – often go into the field because it’s easier to treat others than work on their own issues. This may sound harsh, but after teaching graduate school for over six years I know this to be the case.

I even wrote a brief paper about my own experiences learning how to use the body in helping patients heal from painful emotional wounds. Reading it will give you a clearer picture of what I am talking about.

What is the best way to find a good therapist that can help you work with emotions, and ultimately help you heal from addiction?

1) Study the various approaches above and get a clear idea of what is meant by: working with the body, experiential, somatic, emotion-focused, gestalt, process, etc… Also, beware that there are a number of quick-fix therapeutic approaches like Emotion Freedom Technique that are very different than what I am suggesting here. While these approaches may have some utility for particular issues, learning to developmentally get comfortable with emotion is not something you can do overnight.

2) Read How to Find a Good Therapist and then begin seeking out clinicians in where you live that do this kind of work. Often, seeking out therapists that advertise as trauma specialists is one of the best ways to find someone who knows how to work with emotion.

3) Test the waters by doing a session with your top choice and let them know you want to experience how they work with the body. You will know when you hit gold and find someone that can really help you.

If you want to chat more about this topic, or have me help you locate someone where you live that can help you work with emotions, then sign up for a consult and I would be happy to assist you.

]]>http://addictionmanagement.org/emotions-vs-talk-therapy/feed/7Learning From Robin and Philip: Hope For Those Strugglinghttp://addictionmanagement.org/addiction-and-mental-illness-lessons/
http://addictionmanagement.org/addiction-and-mental-illness-lessons/#commentsWed, 13 Aug 2014 20:03:19 +0000http://addictionmanagement.org/?p=3517What are we to make of the recent deaths of two of Hollywood’s Greats: Philip Seymour Hoffman and now, Robin Williams? While they both died at the top of their professional careers, their deaths hit home that fame and fortune are not ingredients of a fulfilled life, and that we don’t have all the answers... [Continue Reading]

]]>What are we to make of the recent deaths of two of Hollywood’s Greats: Philip Seymour Hoffman and now, Robin Williams? While they both died at the top of their professional careers, their deaths hit home that fame and fortune are not ingredients of a fulfilled life, and that we don’t have all the answers when it comes to addiction and mental illness (since both received treatment for their challenges).

Yet both of these talented men have left us some important clues about life and addiction that can be life-saving for those still struggling. The clues relate to how we understand and define addiction, and how we should be treating it.

Three Failed Relationships

Addiction is best defined by examining the relationship one has with self, others and faith. It’s within these three types of relationships that we come to understand addiction fully, and find answers as to how to overcome it. Sadly, if we examine the lives of Robin and Philip, we see that they struggled in all three types of relationships.

1) Relationship with Self

For those who struggle with addiction the relationship with Self is characterized by shame. A deep down sense that the Self is damaged, broken, irreparable. The shame comes from many places, most often early life adverse childhood experiences and from the consequences of acting out behaviors later in life.

While I have no knowledge of the events that shaped the early life of Robin and Philip, I believe they both experienced life in painful ways that necessitated finding methods to numb challenging emotions, the most intense likely coming from fear and anxiety characteristic of all forms of trauma. And for both, alcohol and drugs solved the problem, at least temporarily.

But I would also argue that the one addiction that likely caused the most damage over time was work. They both were so incredibly productive and successful in their careers, that work became just as seductive as alcohol and drugs, serving a similar purpose at keeping them disconnected from the turmoil of their inner worlds. When they were engaged in roles, playing other people, they did not have to be themselves, and thus did not have to wrestle with the inner demons of their own lives.

They were also big stars, which meant that the Self – the Ego – became all powerful. When the ego runs the show, life is very much a rollercoaster ride, lived through the ups and downs of pleasure and pain. Unfortunately, while the highs of being a star took them to the clouds, their lows were responsible for ending their lives.

On Shame

You know, I was shameful, and you do stuff that causes disgust, and that’s hard to recover from. You can say, ‘I forgive you’ and all that stuff, but it’s not the same as recovering from it. It’s not coming back. Robin Williams Interview with The Guardian 2010

On Fear and Anxiety

It’s more selfish than that. It’s just literally being afraid. And you think, oh, this will ease the fear. And it doesn’t.” What was he afraid of? “Everything. It’s just a general all-round arggghhh. It’s fearfulness and anxiety. Robin Williams Interview with The Guardian 2010

LESSON ONE

Treatments for addiction need to transform shame into acceptance. This is done by helping those who suffer appropriately process and treat unresolved adverse childhood experiences (or trauma).

Most important in this therapeutic work is safely releasing the trapped residual fear in the body that perpetuates ongoing addictive behavior, which has been brilliantly written about by Peter Levin and Bessel van der Kolk among many.

2) Relationship with Others

For both Robin and Philip their relationships with others could best be characterized by isolation. This does not mean they were not around other people, or did not have many loving people in their lives, just that at their core, the depth of those relationships was constricted in many ways not easily identified by the outside world (or even perhaps by them).

Most adverse childhood experiences occur at the hands of other people, often by those who are supposed to be protective caregivers. When this happens, the natural reaction is to pull away from people, from the danger and pain, and retreat to a place of safety. Unfortunately, this survival mechanism leads to a process of gradually turning towards soothing objects and experiences (ie addiction) over people, that over time, constricts emotional development and impedes the abilities to initiate, develop and maintain healthy relationships with others.

Robin was married three times and Philip separated with his partner prior to his overdose. While no expert on their personal lives, they clearly struggled with intimacy and took their lives in part because they felt no one really knew or accepted them for who they were.

LESSON TWO

To successfully overcome addiction it’s necessary to developmentally close the gap between one’s emotional age (most often the age when early trauma occurs), and one’s chronological age, eventually transforming isolation into connection.

3) Relationship with Faith

One of the dark sides of fame is that it has the power to usurp the Self or ego in a way that leaves very little room for contemplative work. This means big stars have scant time to discover their true nature because they are constantly being brought back to ego by the nature of being a star! For those who struggle with addiction, the relationship with one’s faith is largely characterized by ignorance. Unfortunately, when the ego is left in charge, suffering without an evolving relationship with faith (without meaning and purpose) can become unbearable.

All the great religious and spiritual mystics throughout time have basically said the same thing: the suffering we endure in life is to help us wake up to our true nature, to the timeless and infinite part of ourselves that is connected to the source of all things. And for our suffering to have meaning, for it to be used to awaken to our true nature, contemplative time must be spent nurturing our relationship with the source beyond self and others. Consistent time must be spent alone, meditatively, in nature, in the present moment, for the relationship to evolve.

This work is not easy, and incredible challenging for those who feel fear when they take time to just be in their bodies, in the present moment. This is why the therapeutic work of the self is so important in paving the way to evolve one’s faith.

LESSON THREE

Addiction is just one of many life challenges that exist to help us find our way to God (or whatever you chose to call that which is beyond self, beyond our earthly world, beyond time and space, and really beyond words).

There are many paths to awakening to our true nature, but what they all have in common is the necessity of contemplative time. This can include meditation, spiritual reading, time in nature, prayer, and many other practices that are wonderfully discussed in Wayne Teasdall’s timeless read The Mystic Heart.

Final Words

Just the other night I watched A Most Wanted Man with Philip in the lead role. He was amazing as usual, but this time watching him perform in one of his last movies was a bit distracting because I kept thinking about the fact that he is now gone.

The deaths of Philip and Robin remind us that Hollywood is not reality, and that real life is challenging, sometimes unbearably so. I too will miss their presence in the world.

]]>http://addictionmanagement.org/addiction-and-mental-illness-lessons/feed/2Why You Should Care About Addiction Treatment Outcomeshttp://addictionmanagement.org/addiction-treatment-outcomes/
http://addictionmanagement.org/addiction-treatment-outcomes/#commentsMon, 11 Aug 2014 20:58:03 +0000http://addictionmanagement.org/?p=3479Outcomes are important because they ultimately provide accountability for those who deliver treatment, and for your own actions. There is a wide continuum of addiction treatment services available depending on severity of symptoms, ranging from outpatient options to residential or hospital stays. As you might imagine, there is a huge range in cost for these services as... [Continue Reading]

]]>Outcomes are important because they ultimately provide accountability for those who deliver treatment, and for your own actions. There is a wide continuum of addiction treatment services available depending on severity of symptoms, ranging from outpatient options to residential or hospital stays. As you might imagine, there is a huge range in cost for these services as well.

Clearly, seeing a private practice clinician once a week for an hour (typically $150/hour) compared to a residential program that charges roughly $2,000/day, will yield very different financial investments at the end of one month: $600 vs. $60,000 investment. And here is where outcomes are important.

If you use a reliable and validated outcome tool to assess your overall symptoms and life function on day 1 of treatment, and then you use that same tool 30 days later to reassess the same things, which intervention option is better? And by how much is it better when we factor in the cost?

But addiction is very different than an acute medical problem like a broken leg, where a 30 day outcome has some meaning. For addiction, we want the benefits of treatment to hold far beyond 30 days! So let’s carry our example a bit further, and check in with you one year later. Two years later. Now how well are you doing?

What outcomes should be measured?

The outcomes will depend on you, and they will depend on what you measure. Earlier in this post I mentioned assessing overall symptoms and life functioning, not just abstinence which for many is the gold standard.

While abstinence can be an important measure, in my opinion it’s not as important as other outcomes, such as:

Progress overcoming your developmental deficits and constrictions

The number of healthy intimate relationships in your life

Whether you have a deeper felt sense of meaning and purpose in your life

How you spend your time

The quality of your emotional life (progress addressing other co-occurring disorders)

Degree to which you have resolved underlying traumas

Your time dedicated to helping others and contributing to bettering the world

Degree to which you have reduced shame

While I can come up with many more outcomes that I feel are more important than abstinence, let me be clear, I am not saying abstinence should not be included on the list! It should be there, but in my book it should be further down the list and used as one data point among many others.

Treatment providers and their outcomes

There are numerous tools to help you measure outcomes, but listing and reviewing them is beyond this post (I will get to it soon!). Right now if you are in treatment, or planning on heading there, ask your providers:

What measures they use to assess outcomes

Explain how they use these measures

What the measures mean

How what you are doing now, will influence where you are at two years later

While most residential programs rarely track long term outcomes, and those in private practice tend not to use formal outcome assessment tools, this brings me back to my final point. If the providers you are investing your time and money in don’t measure what they are doing, then you need to be proactive in finding ways to measure outcomes yourself.

Defining outcomes

Perhaps the easiest way to begin is by making a list of the things you care about, and what outcomes you hope for at some point in the future. The list above may give you some ideas. Then look at your list often and assess whether what you are doing day-to-day still makes sense.

Life is messy, things are constantly changing. Yet if we know what outcomes we seek, if we know our own true north, then despite the storms and chaos of life, we always know which direction to head. We also know when a change in what we are doing is needed. And we are empowered to better assess how we want to invest our time and money in treatment.

Presentation on outcomes

One final thing. Scott Miller is among my favorite clinicians (and researchers) who has studied, written and lectured extensively on outcomes for decades in a way we can all understand. Recently, he provided the keynote address at the 2013 Evolution of Psychotherapy Conference where he nicely sums up outcomes, not specifically for addiction, but for therapy in general, in a great 45 minute presentation which I encourage you to watch.